On October 28th Hurricane Sandy hit the East Coast of the US, affecting the lives and wellbeing of more than 50 million people. The greater New York City area was heavily struck by the hurricane. The psychological devastation of the hurricane, along with the mental health consequences of being displaced, major loss of property, flooding, mold, prolonged lack of heat, water and power, are unknown. Estimates can be drawn from anecdotal reports from health providers, first responders, hospitals and shelters, however, reliable data is lacking in terms of the prevalence of psychological health effects. The current study aims to understand the psychological impact of this hurricane in an effort to inform current intervention and future prevention efforts. This application represents a partnership between a large hospital system, the North Shore-LIJ Health System (NSLIJHS), and the Nassau County Department of Human Services which is the agency that oversees all mental health agencies in the county. NSLIJHS consists of 16 hospitals spanning across Nassau county, Suffolk county, Queens, Manhattan and Staten Island, encompassing areas most affected by Hurricane Sandy. The goals of the current project include establishing associations between exposure to the hurricane and various mental health symptoms and diagnoses while also defining subgroups of individuals who were most vulnerable to mental health effects due to the hurricane. We will accomplish this using multiple methodologies including survey data from a cohort of at least 500 individuals who reside in Nassau, Suffolk, Queens or Richmond (Staten Island) counties as well as using Emergency Department (ED) data from the 14 EDs that are part of the NSLIJHS. Further, we will also investigate the impact of various displacement strategies on the mental health of residents using the survey data and we will examine the psychological impact of the hurricane on those who indicate that they are first responders. Ultimately, our research will result in two significant products. The first is a vulnerability profle of those most affected by Hurricane Sandy in terms of psychological health and wellbeing. This profile will be accompanied by tables and other user-friendly charts and diagrams for local government agencies, mental health agencies, emergency preparedness agencies, health care workers, and the NSLIJHS (among others) to use in order to continue to target current intervention strategies for those highly affected by the hurricane and most vulnerable to its effects as well as to inform emergency preparedness efforts by indicating areas and groups to prioritize in terms of mental health intervention during future natural disasters. Second, our work will produce a Hurricane Sandy cohort and database that can be tracked and followed over time. The database will be available to researchers and other key stakeholders in order to examine the long-term impact of hurricane exposure, to continue to provide important information as to emergency preparedness for future hurricanes and other natural disasters, as well as for community groups and those in the scientific emergency preparedness community to leverage additional funding for future research and intervention endeavors. Ultimately, we see this work as an integral first step toward the development of a NSLIJHS ED syndromic surveillance system as well as a first step towards the development of an Emergency Preparedness Research Center that will provide important and timely information to community groups and health care providers throughout the region. The goals of this proposal are feasible and reasonable because of the strong community linkages that already exist by all members of the research and Project Advisory Board team. We consulted with many community groups including members of government agencies, hospital administrators, community coalitions and network members among many others in the development of this project. Further, we have already confirmed its feasibility in the community given the successful pilot study that was conducted with 107 participants. We plan to work collaboratively with key stakeholders including our community partners during each step of the project from implementation through dissemination and translation. Our community partners are key to the efficacy of the project especially in terms of the dissemination of our research findings, vulnerability profile and cohort database. We will use multiple methods and media to effectively disseminate to key groups on both local and national levels. Further, given that one of the co-PIs is the Commissioner of the Department of Human Services and has strong connections to government agencies including emergency preparedness groups, mental health agencies and first responders throughout the affected region, we will easily be able to translate our findings into public health practice.